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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608023
Report Date: 08/10/2022
Date Signed: 08/10/2022 11:01:59 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/07/2021 and conducted by Evaluator Wendell Smith
COMPLAINT CONTROL NUMBER: 31-AS-20210907120635
FACILITY NAME:SUNGATE CARE FACILITYFACILITY NUMBER:
197608023
ADMINISTRATOR:TASHA KANALEYFACILITY TYPE:
735
ADDRESS:3441 SUNGATE DR.TELEPHONE:
(661) 526-7848
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:4CENSUS: 4DATE:
08/10/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Arnicea JohnsonTIME COMPLETED:
11:05 AM
ALLEGATION(S):
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Staff hit a client while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent complaint visit to finish investigation into the allegation above. LPA met with the house manager and explained the reason for the visit. LPA spoke with the administrator by telephone and explained the reason for the visit.
LPA conducted a physical plant tour from 9-9:10am to ensure no immediate health and safety issues and none were observed.
Regarding the allegation above it is alleged that staff #1 (S1) hit client #1 (C1). Initial complaint visit was done on 9/8/21 by LPA Spaeth. During that visit interviews were conducted with C1 and facility staff regarding the incident. During today's visit LPA conducted interviews with facility staff from 9:10-10am and obtained copies of incident reports related to the incident. Information from all interviews reveal that C1 attacked S1 on multiple occassions by throwing hot beans off of the stove at S1, hitting S1 in the back of the head with a pot, and hit S1 with their fist. During the incident both S1 and C1 fell to the ground. Witnesses that saw the altercation did not see S1 strike C1 at all. C1 was seen at the hospital for bruising under their eyes but no broken bones.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20210907120635
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNGATE CARE FACILITY
FACILITY NUMBER: 197608023
VISIT DATE: 08/10/2022
NARRATIVE
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Based on the information obtained through interviews, record review, and incident reports received this allegation is deemed Unsubstantiated at this time. No one who witnessed the altercation saw S1 hit C1 on any occasion but did witness C1 attacking S1 continuously and saw S1 trying to protect themselves.

Exit interview conducted. Copy of report issued.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2